Provider Demographics
NPI:1346773546
Name:WILBUR, ANDREW JAMES (MD (JUNE 2017))
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:WILBUR
Suffix:
Gender:M
Credentials:MD (JUNE 2017)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ESSEX ST STE 204
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3245
Mailing Address - Country:US
Mailing Address - Phone:201-487-1240
Mailing Address - Fax:
Practice Address - Street 1:256 COLUMBIA TPKE STE 209
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1238
Practice Address - Country:US
Practice Address - Phone:201-487-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA115466002084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry